The number of bariatric surgery procedures is likely to increase in the US in response to rising rates of morbid obesity, according to two recently published studies.

The first study, Bariatric Surgery for the Management of Obesity: State of the Field, published in the October issue of Plastic and Reconstructive Surgery, claims that the prevalence of obesity has dramatically increased in the last decade and this will continue to fuel the demand for bariatric surgical solutions.

“In 1990, not one state had a prevalence of obesity greater than 15%, whereas in 2009, only Colorado and the District of Columbia had prevalence less than 20%,” Drs Bruce Wolfe and Erin Gilbert, Oregon Health and Science University, Portland, note in the paper. “Not only is obesity a significant risk factor for many [diseases], but it also is associated with an overall increase in mortality and a reduction in life span of ten year.”

The authors reviewed and summarised the latest data on the use and outcomes of bariatric surgery for the management of morbid obesity, and reported over the last decade the increase in bariatric procedures parallels the rising rates of obesity in the US.

However, a recent study by Henry Buchwald has indicated that the number of procedures may have plateaued and in some instances maybe declining. Furthermore, a recent earnings conference call from Allergan revealed a sharp drop in the number of Lap-Band procedures in the US.

The researchers reviewed the three main options for bariatric surgery: adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass. The expected percentage of excess weight loss is approximately 48% after adjustable gastric banding and 61% after sleeve gastrectomy and gastric bypass.

“Plastic and reconstructive surgeons have a unique role in dealing with aesthetic problems after massive weight loss and must understand the principles and expected benefits of bariatric surgery procedures, as well as the characteristics and potential medical risks of patients undergoing these procedures,” the authors state.

It is especially important for plastic surgeons to understand the concepts and outcomes of bariatric surgery procedures, as there is a fast-growing population of patients seeking body contouring surgery.

The investigators cite statistics from the American Society of Plastic Surgeons, which show sharp increases in the demand for body-contouring procedures (such as lower body lift, upper arm lift and abdominoplasty) over the past decade.

However, they emphasise that for most patients body contouring should be delayed until their weight has stabilised for at least three months, which may take a year or longer after surgery.

It is also important to carefully screen patients for on-going medical issues such as diabetes, heart disease or obstructive sleep apnoea.

Nutritional deficiencies are also common after bariatric surgery, including protein malnutrition and deficient levels of nutrients such as vitamin B12, vitamin D, iron, calcium and folate. All of these conditions should be identified and corrected before body contouring is performed.

The growth of bariatric surgery may increase even further as the overall safety profile continues to improve. In addition, the number of adolescent patients undergoing surgical treatment for obesity is likely to increase as future studies verify the safety of bariatric surgery in this age group.

“Given the increasing incidence of morbid obesity and the effectiveness of bariatric surgery in treating this disease, it will likely continue to increase in popularity,” the authors conclude.

Severely obese

The second study, Morbid obesity rates continue to rise rapidly in the United States, published in the International Journal of Obesity, reported that the proportion of Americans who are severely obese (BMI> 40) continues to increase rapidly and much faster than those with moderate obesity.

The research, undertaken by the Rand Corporation, found that from 2000 to 2010, the proportion of Americans who were severely obese increased by 70% from 3.9% of the population to 6.6% (more than 15 million adult Americans).

However, beginning in 2005, the near-exponential growth of the severely obese group began to flatten out.

“The proportion of people at the high end of the weight scale continues to increase faster than any other group of obese people, despite increased public attention on the risks of obesity,” said Roland Sturm, lead author of the report and a senior economist at Rand. “But for the first time in the past 20 years there is evidence the trend is slowing.

The report found that the typical distribution for severely obese males was a weight of 300lbs and a height of 5 feet 10 inches. The typical distribution for severely obese females was a weight of 250lbs and a height of 5 feet 4 inches.

The study suggests that clinically severe obesity is an integral part of the population's weight distribution. As the whole population becomes heavier, the severely obese population increases the fastest.

The trend of severe obesity varies by gender and ethnicity, although the trend remained upward among all groups. The prevalence of severe obesity was about 50% higher among women than among men, and approximately twice as high among blacks when compared with Hispanics or whites. For all levels of obesity, the increases over time were faster among age groups younger than 40 years of age.

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